International Journal of Pediatric Otorhinolaryngology
Special reportHearing impairment prevention in developing countries: making things happen
Introduction
Many developing countries are confronted with the challenge of an overwhelming burden of infectious and deadly diseases. Thus, it is not uncommon to find that health-care needs in most of these countries are ranked into high and low priorities.
Life-threatening conditions and diseases such as diphtheria, tetanus and meningococcal meningitis naturally engage the keenest attention of healthcare managers. In contrast, other conditions perceived as non-life threatening such as hearing impairment and deafness are generally neglected. This action is often justified on the basis of the limited resources available to most governments in developing countries from own revenue, grants and donations by international agencies. Current statistics in fact, indicate a global decline in grants and donations from the rich nations of the world to developing countries [1].
The adverse impact of hearing impairment on the acquisition of linguistic skills in children and psycho-social conditions in adults are well established. It is also known that hearing impairment places severe limitations on educational and economic pursuits essential to achieving a good quality of life. Hearing loss in majority of cases is irreversible, while the cost of rehabilitation is not readily affordable.
Given this scenario, how can we engineer a change in response and action towards its prevention and management as widely advocated? This paper discusses a change-process mechanism that could assist programme coordinators at all levels in optimizing the limited opportunities and resources available for this task.
Section snippets
Global and regional initiatives
The World Health Organisation (WHO) in its Alma-Ata Declaration at the 32nd World Health Assembly (WHA) [2] reaffirmed that health is not simply the absence of disease or infirmity but a state of complete physical, mental and social well-being. It recognized the provision of health at the highest possible level as a necessary social goal by all governments and health authorities. This declaration was adopted in 1981 thereby changing the focus of WHO from disease management to total well-being.
Prevention programme as a social change
Typically, when the programme content has been agreed the next stage involves determining what strategies would be followed to implement the programme. Thereafter, the deployment of manpower and material resources comes into focus. However, the provision of requisite human and material resources is too often regarded as the only critical success factor at this stage. This unfortunately, overlooks the nature and process of the social change, which underlies the programme. It is, therefore, not
Evaluating the change players
The various parties and workers enlisted into the task of hearing impairment prevention and management can be classified into four main groups as illustrated in the figure below:
For clarity, the knowledge of change content in our context is defined as the knowledge and appreciation of the significance of hearing disability, its prevalence, the value of its prevention, early detection and effective management.
Readiness for change is determined by the extent of the action or interest demonstrated
Mobilizing the change agents
In practice limited choice may exist in securing the right calibre of workers for the programme. However, it is necessary that any categories A, B, or C workers currently or likely to be engaged are rapidly assisted to become change agents.
For instance those in group A would require training to acquire new skills and counselling on the benefits of the programme. It is not unlikely that the acquisition of the requisite knowledge of the proposed programme may in itself stimulate a readiness for
Implementing the change programme
It is evident from the foregoing that any attempt by governments, health authorities or funding agencies to deploy resources to the various workers involved in prevention programmes on hearing impairment without regard to their status or disposition to the required change may be counter-productive. The knowledge of the change programme and readiness or commitment to the programme cannot be presumed. It must be carefully evaluated. The mobilization of change agents and their empowerment through
Conclusion
Many developing countries are not short of plans and programmes. The perennial hurdle has always been how to achieve reasonable balance in priorities in the face of competing needs and limited resources. Hearing impairment presents an additional and unique challenge by its very nature as an invisible handicap that is non-life threatening. Therefore, any attempt by these countries to promote an effective prevention programme must approach this task as a social change in which economic resources
Acknowledgements
The author wishes to acknowledge the contributions of Prof. Paul Strebel on the subject of change management.
References (8)
- S. Ramphal, Debt has a child's face, The Progress of Nations Publication, UNICEF 1999, pp....
- The Work of WHO 1978–1979: Biennial Report of the Director-General to the World Health Assembly and to the United...
- Prevention of hearing impairment, Resolution of the 48th World Health Assembly, 12 May 1995, WHA...
- Report of the Working Group on Prevention of Hearing Impairment and Deafness, World Health Organisation Western Pacific...
Cited by (20)
The Professional's experience with causes of delay in the diagnosis and management of children with a congenital hearing loss in Libya
2020, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :Ultimately, it is clear that all these causes have a role to play on this issue in Libya. The reports by Olusanya (2000 and 2007) [10,36], state that despite the efforts of the WHO and other international health organizations to improve the prevention and management of CHL in developing counties, there has been only slow progress because of the lack of adequate financial support and attention of health officials. More effort is necessary to change the attitudes, perception and beliefs about the importance of non-life threating disease prevention, such as hearing loss, and its effects on the quality of life [7,40].
Highlights of the new WHO Report on Newborn and Infant Hearing Screening and implications for developing countries
2011, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :Systematic dissemination of the WHO Report to pediatricians and primary health care providers will also help to create improved public awareness on the importance of NHS. No matter our individual research and clinical skills or experience nothing of public health significance is likely to happen on this or any other related subject without sustained collective advocacy and enthusiasm [10]. Let's seize this momentum to develop effective services for all infants with hearing impairment in our respective communities.
Early hearing detection and intervention in South Africa
2009, International Journal of Pediatric OtorhinolaryngologyEarly hearing detection at immunization clinics in developing countries
2006, International Journal of Pediatric OtorhinolaryngologyBenefits and challenges of newborn hearing screening for developing countries
2004, International Journal of Pediatric OtorhinolaryngologyMaternal knowledge and views regarding early hearing detection and intervention in children aged 0–5 years at a semi-urban primary care clinic in South Africa
2020, South African Journal of Communication Disorders